Hansen Arne, Herrmann Maximilian, Ehlers Jan P, Mondritzki Thomas, Hensel Kai Oliver, Truebel Hubert, Boehme Philip
Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Johnson & Johnson Medical GmbH, Production Planning & Logistics, Norderstedt, Germany.
JMIR Public Health Surveill. 2019 Oct 28;5(4):e14689. doi: 10.2196/14689.
Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate.
We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption.
This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market.
There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses "H8: Digitization in the health care system will free up jobs," and "H6: Digitization in the health care system will empower the patients," perceived to be in profound disagreement (P=.036 and P<.001, respectively).
Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree.
全球医疗保健系统都在努力控制成本上升，而许多疾病的治疗效果改善却很有限。利用人工智能或机器学习算法等技术实现数字化或许可以解决这一问题。尽管数字技术已成功应用于临床研究，但迄今为止，其对整个医疗保健系统的影响仍然有限。监管生态系统或数据隐私可能是原因所在，但其他因素或许也占主导地位。
我们分析了德国医疗保健市场数字化目前在不同利益相关者中的认知情况，并调查了其适应缓慢的原因。
这是一项混合方法研究，分为定性的A部分（采用扎根理论的概念方法）和定量的B部分（采用德尔菲法）。对于A部分，我们采访了医疗保健系统专家，并将结果转化为17个假设。德尔菲法包括一项在线调查，通过电子邮件发送给参与者，为期三个月。为评估这17个假设，参与者使用六点李克特量表。参与者分为德国医疗保健市场中的患者、医生和服务提供者。
专家（N = 21）和调查参与者（N = 733）对这些假设的意见高度一致，17个假设中有12个总体达成率为70.5%。医生与专家小组的意见一致性最低，有88%（15/17）不一致，其中假设“H8：医疗保健系统数字化将创造新的就业机会”和“H6：医疗保健系统数字化将增强患者的能力”被认为存在严重分歧（分别为P = 0.036和P < 0.001）。
尽管参与者和专家在数字化对医疗保健系统的影响方面达成了坚定共识，但医生表现出更为消极的态度。我们认为这可能是导致数字化在实践中采用缓慢的一个因素。医生可能在应对权力结构的变化，因此未来改变市场的措施应更大程度地让他们参与进来。
